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One of the last things Andy Burnham did before entering Downing Street was to go and see his father.
Now living in a nursing home, Roy Burnham has Alzheimer’s and isn’t really aware of his son’s new job. But perhaps the prime minister wanted, in part, to try to explain why he might not be visiting so often in future.
He wouldn’t be the first middle-aged child torn between work pulling one way and elderly parents the other, ending up desperate for a politician willing (as Burnham Jr says he is) to “expend quite a lot of political capital” on the historically vote-losing task of fixing social care. For the alternative is families expending capital – financial and emotional – they don’t have.
Generation X is now entering its caring years, and unlike previous generations, attempting it while both halves of a couple are simultaneously working full-time jobs. We’re crisscrossing the country between homes far away where we spent our childhoods, and those where our own children are still growing up; dealing with muddles over medication at one end and A-level stress at the other, shuttling from hospital waiting rooms to parents’ evenings in constant fear of dropping a ball somewhere. If working motherhood is mostly being in two places at once, middle-aged daughterhood is being in three: work, home and wherever your parents are, greeted at every turn by accusatory piles of laundry and nagging guilt about not being there (anywhere) enough. Care tax? We’re paying it already: it’s just that nobody calls it that.
The invisible tax on not having a universal care service in England particularly – Wales has a more generous system of means-testing, and Scots get free personal care – is paid most obviously in nursing home fees (on average £5,192 a month, for those with assets of over £23,250 in England and Northern Ireland) or visiting home care workers at up to a pound a minute. But it’s also paid in time, energy, carers’ own health and sanity, and sometimes their jobs. The charity Carers UK reckons 2.6 million people have given up work due to unpaid caring for a loved one; 61% of those still working say it affects the jobs they can do, with a fifth settling for lower-paid or more junior roles. So employers, too, pay the invisible tax, every time they lose good people, while the whole country pays it in lost economic activity, and in every night spent in hospital by a patient who could be at home if they’d had better support. (Anticipating and preventing a fall, pressure sore, or other cause of rapid downward spiral beats expensively treating the consequences, as Burnham will know from Manchester’s pioneering attempts to shift health and care spend towards prevention.)
Yet Westminster sees only the scary price tag on free care, and is paralysed into doing nothing.
It’s not for lack of family experience that every politician approaching this subject hurriedly backed away. David Cameron was the devoted father of a profoundly disabled son – it’s often forgotten that social care is about children too – and his mother had Alzheimer’s. Theresa May’s and Keir Starmer’s mothers were disabled by multiple sclerosis and Still’s disease respectively. Andy Burnham said he was motivated by his granny’s struggles when, as health secretary in 2009, he first proposed a national care service funded by a 10% inheritance levy on all estates. But the plan was doomed the minute the Tories dubbed it a “death tax”, running attack ads covered in gravestones.
Since then, the clamour for something to be done has only grown, but taxing inheritance has become more fraught, with millennials banking on the wealth locked up in their parents’ houses to become homeowners themselves.
But the whole point of an inheritance levy is to stop you losing everything if the worst happens – much like house insurance, which many of us fork out for automatically. One in three people end up in a nursing home, costing on average more than £67,000 a year, for an average of two years for care homes without nursing, one year for care homes with (though often longer for dementia sufferers). The trouble is that human nature means most people like to think they’ll never need nursing care, and so become convinced they’ll end up paying more in death taxes than they get out. If he is to succeed where he failed before, then Burnham must show that, like the NHS it mirrors, his universal care service offers something for everyone.
Make it, then, a service for ageing well. Make it as visible as SureStart was for new parents, with one-stop centres dispensing advice, activities for older people, and helping families through a lonely and confusing time. Introduce Japanese-style routine assessments for over-65s, as recommended by the IPPR thinktank, picking up future risks while there’s still time to improve bone strength or balance. Pitch it as a service taking the fear and indignity out of ageing, while preserving your children’s financial security to boot.
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Turn Louise Casey’s review of social care into a short national conversation about what constitutes a good old age; don’t let parliament debate the right to die again without a parallel right to live well to the end. And if people still don’t want a death tax? Tell them the chances are they’ll end up paying an invisible one anyway; at least this way, someone bothered to ask them first.
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Gaby Hinsliff is a Guardian columnist
